Sex, gender, and hemorrhagic fever viruses

Abstract

It is estimated that more than 100 million individuals worldwide are annually infected with viruses that can cause a viral hemorrhagic fever (VHF). The pathogenesis behind various forms of VHF is generally not well understood, hampering the development of vaccines and specific treatments. Despite their importance for public health, there is with some exceptions currently a lack of safe vaccines and effective drugs. Ribavirin, an antiviral compound, is used for treatment of certain forms of VHFs, but unfortunately it has teratogenic effects and is therefore not recommended for pregnant women. In general, little is currently known regarding possible sex and/or gender differences in risk of exposure to VHFs and if there are sex differences in severity of and/or mortality from VHF. Further, little is known regarding possible sex differences in effects and side effects of the vaccines and treatments currently in use. Where data exists, it is often contradictory; for example, more cases of hantavirus infection are recognized among males than females. Seroprevalence data, however, show a more equal sex distribution, suggesting either a gender bias in case recognition, diagnoses, or both. Conversely, there might also be a sex difference in biological susceptibility to hantavirus infection. Strikingly, at present there are gaps of knowledge regarding possible sex differences in susceptibility, disease presentation, severity, and outcome in VHF. Additional clinical and epidemiological studies are needed to improve our understanding of these often fatal infectious diseases.